Robert L. Deters, MD

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

81664 Issued in SC

Practice address

222 East Medical Lane
Suite 200
West Columbia, SC 29169-4801

Phone

(803) 935-8410

Fax

(803) 936-7816

NPI assigned

Sep 6, 2005

Last updated

Oct 27, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 5

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bernard a Westerling III, MD, LLC

  • Family Medicine Physician
  • Fitchburg, MA
  • NPI 1366606246
  NPD (past)
• Cheshire Anesthesia Associates, P.a.

  • Anesthesiology Physician
  • Keene, NH
  • NPI 1770538522
  NPD (past)
• Coordinated Primary Care, Inc.

  dba HealthAlliance Pediatric Hospitalists Group

  • Hospitalist Physician
  • Leominster, MA
  • NPI 1851623714
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603756800000",
    "number": "1942294004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6069",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291716069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 EAST MEDICAL LANE",
            "address_2": "SUITE 200",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291694801",
            "telephone_number": "803-935-8410",
            "fax_number": "803-936-7816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETERS",
        "first_name": "ROBERT",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-06",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MA",
            "license": "78809",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "NH",
            "license": "11526",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "MA",
            "license": "78809",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "SC",
            "license": "81664",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3118916",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110053869A",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "80667",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30201961",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "M20928",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rdeters84236@direct.lexmed.com",
            "affiliation": "N",
            "address_1": "222 East Medical Lane",
            "address_2": "Suite 200",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "country_code": "US",
            "postal_code": "291694801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Dentist in West Columbia LLC (Dentist in West Columbia)
• Dentists of West Columbia, PC (Dentists of West Columbia)
• John D. Deperi, M. D.
• Jeffrey Scott Derenzo, DPT
• Kessler Derrrick, PHARMD
• Heather Detwiler, PTA
• Karen Ann Devereaux, COTA
• Kristin K Devito, PA
• Jackara Shadasha Dewalt
• Raymond E Diamond, DO

• Interventional Pain Medicine Physician in West Columbia, SC
• Providers in West Columbia, SC by specialty
• Interventional Pain Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.